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1.
Arq. gastroenterol ; 58(3): 281-288, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345285

ABSTRACT

ABSTRACT BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is an important option for enteral nutrition for both children and adults. It is considered a safe, effective, and advantageous technique in comparison to other complementary feeding routes. It allows continuous feeding, the feeding of patients with swallowing disorders due to neurological causes or others, and the administration of non-palatable diets or medications, all with low rates of complications and mortality. OBJECTIVE: This study aimed to evaluate the main indications and complications of PEG in pediatric patients. In addition, the impact on the nutritional status of patients undergoing PEG was also compared with weight, body mass index (BMI), and height according to references from the World Health Organization. METHODS: This observational and retrospective study included 152 children and adolescents who underwent PEG between January/2003 and December/2018. Patients up to 18 years of age at the time of the procedure were included. Complications related to the procedure were classified as minor or major. Patients with PEG indication for nutritional supplementation were evaluated for weight gain, height, and BMI, using the Z score at the day of the procedure and six months, 1 year, and 2 years after the procedure. RESULTS: Indications for PEG were: swallowing disorder of neurological cause (67.1%), need for nutritional supplementation (25%), swallowing disorder of mechanical origin (6.6%), and indication of gastric decompression (1.3%). Minor complications occurred in 57.8% of patients and major complications in 9.8% of patients. The traction technique corresponded to 92.1% and puncture to 7.9%. The death rate was 1.3%. Thirty-eight patients had an indication for nutritional supplementation. In these patients, there was a gradual increase in both BMI and weight, reaching statistically significant differences (P=0.0340 and P= 0.0105, respectively). These differences were more evident in chronic renal disease patients. Height did not vary significantly (P=0.543). CONCLUSION: PEG proved to be an advantageous option as an auxiliary feeding method in pediatric patients. Dysphagia of neurological origin was the main indication followed by the need for nutritional supplementation. PEG has low frequency of major complications and mortality. This study also showed the importance of PEG in patients who need nutritional supplementation, as it enabled patients to move from undernutrition to normal weight ranges.


RESUMO CONTEXTO: A gastrostomia endoscópica percutânea (GEP) é uma importante opção de nutrição enteral para crianças e adultos, sendo considerada uma técnica segura, eficaz e vantajosa em comparação às outras vias de alimentação complementar. Permite a alimentação contínua, a alimentação em pacientes com distúrbios de deglutição de causa neurológica ou outros, a administração de dietas ou medicamentos não palatáveis, todos com baixos índices de complicações e mortalidade. OBJETIVO: Avaliar as principais indicações e complicações de pacientes pediátricos submetidos à GEP e o impacto no estado nutricional de pacientes submetidos à GEP para suplementação nutricional, comparando peso, índice de massa corporal (IMC) e estatura com referências da Organização Mundial de Saúde. MÉTODOS: Estudo observacional e retrospectivo de 152 crianças e adolescentes submetidos à GEP, no período de janeiro/2003 a dezembro/2018. Foram incluídos pacientes até 18 anos de idade na época do procedimento. As complicações relacionadas ao procedimento foram divididas em menores e maiores. Pacientes com indicação de GEP para suplementação nutricional foram avaliados quanto ao ganho de peso, altura e IMC, por meio do escore Z no dia do procedimento e 6 meses; 1 ano; e 2 anos após o procedimento. RESULTADOS: As indicações para GEP foram distúrbio de deglutição de causa neurológica (67,1%), necessidade de suplementação nutricional (25%), distúrbio de deglutição de origem mecânica (6,6%), e indicação de descompressão gástrica (1,3%). Complicações menores ocorreram em 57,8% dos pacientes e complicações maiores em 9,8%. A técnica de tração correspondeu a 92,1% e a punção, 7,9%. A taxa de mortalidade foi de 1,3%. Trinta e oito pacientes tinham indicação de suplementação nutricional. Nestes, houve aumento gradativo tanto do IMC quanto do peso, com variação estatisticamente significativa da mediana P=0,0340 e P=0,0105, respectivamente, mais evidente nos pacientes renais crônicos. A altura não variou significativamente (P=0,543). CONCLUSÃO: A GEP mostrou-se uma opção vantajosa como forma auxiliar de alimentação em pacientes pediátricos, tendo como principais indicações a disfagia de causa neurológica e a necessidade de suplementação nutricional, com baixa prevalência de complicações maiores e mortalidade. Este estudo também mostrou a importância da GEP em pacientes com necessidade de suplementação nutricional, possibilitando a passagem dos pacientes desnutridos para escores nutricionais de peso adequados à idade.


Subject(s)
Humans , Child , Adolescent , Adult , Gastrostomy/adverse effects , Malnutrition , Retrospective Studies , Treatment Outcome , Enteral Nutrition
2.
Rev. colomb. gastroenterol ; 36(supl.1): 107-111, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251557

ABSTRACT

Resumen El vólvulo gástrico es una entidad rara que puede presentarse de manera aguda o crónica y se acompaña de síntomas inespecíficos. Es fundamental su rápida identificación, ya que tiene alta mortalidad y el tratamiento oportuno de esta patología determina el pronóstico del paciente. A continuación, presentamos el caso de una paciente femenina de 89 años, que consulta por cuadro clínico de dolor torácico atípico, con documentación en radiografía de tórax de vólvulo gástrico organoaxial, en quien se realiza inicialmente devolvulación endoscópica con éxito. Sin embargo, en las imágenes de control se evidencia recurrencia del vólvulo, por lo cual se realizó manejo quirúrgico con hiatoplastia y funduplicatura tipo Toupet, además de gastrostomía percutánea de fijación, procedimiento realizado sin complicaciones, con los que se logró la devolvulación completa sin recurrencia.


Abstract Gastric volvulus is a rare condition that can occur acutely or chronically and is accompanied by nonspecific symptoms. Its rapid identification is critical since it has high mortality rate and timely treatment determines the patient's prognosis. The following is the case of an 89-year-old female patient who presented with atypical chest pain, with organoaxial gastric volvulus on chest X-ray, in whom endoscopic devolvulation was initially performed successfully. However, control imaging scans revealed recurrence. Therefore, surgical management included hiatoplasty and Toupet fundoplication, as well as percutaneous fixation gastrostomy, a procedure that was completed without complications and resulted in complete devolvulation without recurrence.


Subject(s)
Humans , Female , Aged, 80 and over , Stomach Volvulus , Gastrostomy , Therapeutics , Radiography
3.
Rev. colomb. gastroenterol ; 36(1): 81-86, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1251525

ABSTRACT

Resumen La pancreatitis aguda secundaria a la obstrucción de la papila mayor causada por la migración del balón interno es uno de los efectos secundarios poco frecuentes, pero potencialmente graves relacionados con el uso de gastrostomías endoscópicas percutáneas (PEG). Hasta ahora solo existen 15 casos reportados en el mundo, presentamos el que para nuestro conocimiento sería el caso número 16 en la literatura internacional.


Abstract Acute pancreatitis secondary to major papilla obstruction caused by intragastric balloon migration is one of the rare but potentially severe side effects associated with the use of percutaneous endoscopic gastrostomy (PEG). To date, there are only 15 cases reported worldwide. This article presents a case that, to the best of our knowledge, is the sixteenth case reported in the international literature.


Subject(s)
Humans , Male , Female , Pancreatitis , Gastrostomy , Literature
4.
Rev. cuba. cir ; 60(1): e937, ene.-mar. 2021. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1289378

ABSTRACT

Introducción: La estenosis tardía y retracción del órgano sustituto al mediastino es una situación compleja. Objetivo: Mostrar una alternativa poco invasiva ante la retracción y retención del colon en el mediastino, posterior a una esofagocoloplastia. Caso clínico: Se presenta una paciente de sexo femenino de 18 años de edad con antecedente de ingestión accidental de caustico al año y medio de nacida. El tratamiento fue una esofagocoloplastia retroesternal, se utilizó el colon derecho. Después de 16 años presentó una fistula esofágica con estenosis y retracción del segmento del colon utilizado hacia el mediastino. Conclusiones: Fue factible extirpar el colon retenido en el mediastino y la esofagogastroplastia tubular ya que siempre ofrece ventajas. Fue muy importante la integración multidisciplinaria entre cirujanos de adultos y pediátricos lo que permitió realizar este procedimiento complejo(AU)


Introduction: Late stenosis and retraction of the substitute organ towards the mediastinum is a complex situation. Objective: To show a minimally invasive alternative to retraction and retention of the colon towards the mediastinum after esophagocoloplasty. Clinical case: The case is presented of an 18-year-old female patient with a history of accidental ingestion of a caustic product at one year and a half after birth. The treatment was a retrosternal esophagocoloplasty, for which the right colon was used. After 16 years, she presented an esophageal fistula with stenosis and retraction of the segment of the used colon towards the mediastinum. Conclusions: It was feasible remove the colon retained in the mediastinum as well as perform the tubular esophagogastroplasty, since it always offers advantages. Multidisciplinary integration between adult and pediatric surgeons was very important, allowing this complex procedure to be performed(AU)


Subject(s)
Humans , Female , Adolescent , Gastrostomy/methods , Esophageal Stenosis/etiology
5.
Rev. colomb. nefrol. (En línea) ; 7(2): 119-122, jul.-dic. 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1251572

ABSTRACT

Resumen La gastrostomía endoscópica percutánea (GEP), descrita por primera vez en la década de 1980, es un procedimiento universalmente utilizado para asegurar la alimentación enteral en pacientes que conservan la función del tracto digestivo, pero que por alguna condición médica o quirúrgica no pueden ingerir alimentos sólidos o líquidos. La realización de una GEP en pacientes con diálisis peritoneal (DP) sigue siendo controvertida, ya que muchos autores la consideran una contraindicación absoluta debido al alto riesgo de morbimortalidad asociada a infección intraperitoneal. Se presenta el caso de un paciente de 70 años, con antecedente de enfermedad renal crónica en estadio terminal y portador de catéter de DP, quien requirió GEP. Se socializa la estrategia utilizada en este caso particular.


Abstract Percutaneous endoscopic gastrostomy (PEG), described in the 1980s, is a procedure universally used to ensure enteral feeding in patients who retain digestive tract function, but who cannot eat solid or liquid foods due to any medical or surgical condition. The performance of PEG in patients with peritoneal dialysis (PD) remains controversial, being considered an absolute contraindication for many authors, taking into account the high risk of morbidity and mortality associated with intraperitoneal infection. We present the case of a 70-year-old patient, with a history of chronic end-stage renal disease with a peritoneal dialysis catheter, who required PEG; and we propose a management protocol for this type of patient.


Subject(s)
Humans , Male , Aged , Gastrostomy , Patients , Indicators of Morbidity and Mortality , Peritoneal Dialysis , Colombia , Renal Insufficiency, Chronic
6.
Rev. bras. anestesiol ; 70(3): 299-301, May-June 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137176

ABSTRACT

Abstract Crisponi syndrome is a rare and severe heritable disorder characterised by muscle contractions, trismus, apnea, feeding troubles, and unexplained high fever spikes with multiple organ failure. Here we report perioperative care for endoscopic gastrostomy of a 17 month-old female child with Crisponi syndrome. Temperature in the surgery room was strictly monitored and maintained at 19ºC. The patient was exposed to both inhaled and intravenous anesthetic agents. Surgical and perioperative periods were uneventful. Episodes of fever in Crisponi syndrome arise from CRLF1 mutation, which differs from the physiological pathway underlying malignant hyperthermia.


Resumo A Síndrome de Crisponi é uma condição clínica hereditária grave e rara caracterizada por contrações musculares, trismo, apneia, distúrbios na alimentação, picos de febre alta e inexplicável, e falência de múltiplos órgãos. Descrevemos o cuidado perioperatório de paciente pediátrica com 17 meses de idade, portadora da Síndrome de Crisponi, submetida a gastrostomia endoscópica. A temperatura da sala de cirurgia foi cuidadosamente monitorizada e mantida a 19ºC. A paciente foi submetida a agentes anestésicos inalatórios e venosos. O cuidado cirúrgico e perioperatório desenvolveram-se sem incidentes. As crises de febre na Síndrome de Crisponi originam-se de mutação no gene CRLF1, o que as diferenciam do mecanismo fisiopatológico da hipertermia maligna.


Subject(s)
Humans , Female , Infant , Trismus/congenital , Hand Deformities, Congenital , Gastrostomy , Facies , Death, Sudden , Hyperhidrosis , Anesthesia, General
7.
Arq. gastroenterol ; 57(1): 3-7, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1098058

ABSTRACT

ABSTRACT BACKGROUND: Cerebral palsy is the most common cause of physical disability in childhood. Caregivers of patients presenting tetraparesis cerebral palsy (TCP) and gastrostomy tube feeding (GTF) were selected for this study because both conditions represent a great demand for their caregivers. OBJECTIVE: To describe the quality of life related to the state of health of caregivers of patients with TCP who were fed by gastrostomy, to assess the results linked to the mental health of these caregivers, to compare our data with data from other studies on children with cerebral palsy without gastrostomy and to evaluate the possible interference of gastrostomy in the quality of life. METHODS: A number of 30 major caregivers were interviewed and assessed. Quality of life and mental health tools applied and analyzed only for caregivers were: Medical Outcomes Study (MOS) 36-item Short Form Health Survey (SF-36), WHOQOL-BREF and Beck scales. Other information (age, gender, marital status, number of residents per household and psychological support) was evaluated. The Spearman's rank correlation coefficient was used to analyze. A 5% significance level was adopted. RESULTS: Results obtained through questionnaires are as follows: moderate hopelessness in 20% of caregivers (the higher the number of residents per household the higher the level of caregiver's hopelessness); moderate and severe anxiety in 33.33% of the sample studied; moderate and severe depression identified in 46.67% of interviewed caregivers; health-related quality of life of caregivers of patients with TCP were found to be below world averages; no significant figures for suicide potential were noted for the population under this study. CONCLUSION: The HRQOL of caregivers of TCP patients who were fed by gastrostomy is below the average of the general population. Our results are very similar to those found in other studies that evaluated caregivers of patients with cerebral palsy with different degrees of neurological impairment and no report of using GTF, suggesting that the presence of gastrostomy did not negatively interfere with the caregiver's HRQOL.


RESUMO CONTEXTO: A paralisia cerebral é a causa mais comum de incapacidade física na infância. Cuidadores principais de pacientes que apresentam paralisia cerebral tetraparética (PCT) em alimentação por tubo de gastrostomia foram selecionados para este estudo porque ambas as condições representam uma grande demanda para seus cuidadores. OBJETIVO: Descrever a qualidade de vida relacionada à saúde (QVRS) de cuidadores de pacientes com PCT alimentados por gastrostomia e avaliar os resultados relacionados a sua saúde mental, comparar nossos dados com dados de outros estudos em cuidadores de crianças com paralisia cerebral sem gastrostomia e avaliar a possível interferência da gastrostomia na qualidade de vida dessa população. MÉTODOS: Trinta cuidadores foram entrevistados e avaliados. Os instrumentos de qualidade de vida e saúde mental foram aplicados e analisados apenas para os cuidadores foram: Medical Outcomes Study 36-item Short Form Health Survey, WHOQOL-BREF e escalas Beck. Outras informações (sexo, idade, estado civil, número de habitantes na mesma casa e suporte psicológico) foram avaliadas. O coeficiente de correlação de Spearman foi utilizado na análise estatística. Foi adotado um nível de significância de 5%. RESULTADOS: Os resultados obtidos por meio de questionários são os seguintes: desesperança moderada identificada em 20% dos cuidadores (quanto maior o número de moradores por domicílio, maior o nível de desesperança do cuidador); 33,33% demonstraram ansiedade moderada e grave; 46,67% depressão moderada e grave; a qualidade de vida relacionada à saúde de cuidadores de pacientes com PCT mostrou-se abaixo da média mundial; não foram observados números significativos de potencial suicida. CONCLUSÃO: A QVRS dos cuidadores de pacientes com PCT alimentados por gastrostomia está abaixo da média da população geral. Nossos resultados são muito semelhantes aos encontrados em outros estudos que avaliaram cuidadores de pacientes com paralisia cerebral com diferentes graus de comprometimento neurológico e sem relato de alimentação por gastrostomia, sugerindo que a presença da gastrostomia não interferiu negativamente na QVRS dos cuidadores.


Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Adult , Young Adult , Quality of Life/psychology , Gastrostomy , Cerebral Palsy/nursing , Caregivers/psychology , Enteral Nutrition , Cerebral Palsy/psychology , Surveys and Questionnaires , Qualitative Research , Middle Aged
8.
Chonnam Medical Journal ; : 75-76, 2020.
Article in English | WPRIM | ID: wpr-787270

ABSTRACT

No abstract available.


Subject(s)
Catheters , Gastrostomy , Hemorrhage
9.
10.
Rev. colomb. cir ; 35(3): 429-435, 2020. tab, fig
Article in Spanish | LILACS | ID: biblio-1123178

ABSTRACT

Introducción. La nutrición se ha considerado tradicionalmente una necesidad básica y el garantizarla se ha asumido como una responsabilidad médica. Se cuestiona la utilización de procedimientos que permitan la nutrición artificial en situaciones clínicas limítrofes, en las cuales su beneficio puede ser limitado o nulo. En el presente estudio se busca determinar el éxito de un procedimiento quirúrgico, la gastrostomía, desde la perspectiva del beneficio para el paciente y, así, aproximarse a una definición de gastrostomía fútil. Métodos. Se llevó a cabo un estudio observacional, retrospectivo y analítico, basado en la revisión de las historias clínicas de los pacientes sometidos a gastrostomía abierta o endoscópica en el Hospital Universitario San Ignacio. El grupo de investigadores principales analizaron los datos para determinar si las gastrostomías practicadas fueron fútiles o no lo fueron. Resultados. Se incluyeron 145 pacientes tratados durante el periodo del 2015 al 2018 y en el 53 % de los cuales se cumplieron los criterios para considerar el procedimiento como fútil. Los procedimientos ­108 endoscópicos y 37 abiertos­fueron practicados principalmente en pacientes con neoplasias de cabeza y cuello, y enfermedades neurológicas. Si bien no hubo mortalidad asociada con el procedimiento, 26 de los pacientes fallecieron en los primeros 15 días después de la intervención. Discusión. El determinar en qué condiciones se debe considerar la gastrostomía una intervención realmente beneficiosa es un desafío. Es necesario incorporar un análisis ético, antes de ofrecer este procedimiento, con el fin de minimizar las gastrostomías innecesarias que actualmente constituyen un problema global


Introduction. Nutrition has traditionally been considered a basic need and ensuring it has been assumed as a medical responsibility. The use of procedures that allow artificial nutrition in borderline clinical situations is questioned, in which their benefit may be limited or null. The present study seeks to determine the success of a surgical procedure, gastrostomy, from the perspective of benefit to the patient and, thus, to approximate a definition of futile gastrostomy. Methods. An observational, retrospective and analytical study was carried out, based on the review of the medical records of patients undergoing open or endoscopic gastrostomy at the Hospital Universitario San Ignacio. The group of main researchers analyzed data to determine if the gastrostomies performed were futile or not.Results. Results. A total of 145 patients treated during the period from 2015 to 2018 were included, and 53% of whom met the criteria to consider the procedure as futile. The procedures - 108 endoscopic and 37 open - were practiced mainly in patients with head and neck malignancies, and neurological diseases. Although there was no mortality associated with the procedure, 26 of the patients died in the first 15 days after the intervention.Discussion. Determining under what conditions a gastrostomy should be considered a truly beneficial intervention is challenging. It is necessary to incorporate an ethical analysis, before offering this procedure, in order to minimize unnecessary gastrostomies that currently constitute a global problem


Subject(s)
Humans , Medical Futility , Gastrostomy , Nutritional Status , Evaluation of the Efficacy-Effectiveness of Interventions
11.
Einstein (Säo Paulo) ; 18: eRC5409, 2020. graf
Article in English | LILACS | ID: biblio-1133733

ABSTRACT

ABSTRACT Percutaneous endoscopic gastrostomy is used to provide enteral nutritional support for patients with obstructive oropharyngeal or esophageal neoplasms. The placement of the catheter is considered safe, with few complications. Despite this, a specific complication that is considered rare, has been increasingly described in the literature, i.e., metastasis of head and neck cancer in the gastrostomy stoma. In this report, we described a case of metastasis of squamous cell carcinoma of the larynx in the gastrostomy site, and discussed the possible etiologies and alternatives, seeking to reduce the incidence of this complication.


RESUMO A gastrostomia endoscópica percutânea é utilizada para oferecer suporte nutricional enteral para pacientes com neoplasias obstrutivas de orofaringe ou esôfago. A colocação da sonda é considerada segura, com poucas complicações. Apesar disso, uma complicação em particular, considerada rara, está sendo cada vez mais descrita na literatura: a metástase de neoplasia de cabeça e pescoço para o estoma da gastrostomia. Neste relato, descrevemos um caso de metástase de carcinoma espinocelular de laringe para o sítio da gastrostomia, e discutimos as possíveis etiologias e alternativas, buscando diminuir a incidência desta complicação.


Subject(s)
Humans , Male , Stomach Neoplasms/secondary , Esophageal Neoplasms/pathology , Gastrostomy/adverse effects , Carcinoma, Squamous Cell/secondary , Oropharyngeal Neoplasms/pathology , Laryngeal Neoplasms/pathology , Head and Neck Neoplasms/pathology , Stomach Neoplasms/surgery , Carcinoma, Squamous Cell/therapy , Carcinoma, Squamous Cell/diagnostic imaging , Enteral Nutrition/adverse effects , Head and Neck Neoplasms/therapy , Middle Aged , Neoplasm Metastasis
12.
Einstein (Säo Paulo) ; 18: eAO4952, 2020. tab, graf
Article in English | LILACS | ID: biblio-1056063

ABSTRACT

ABSTRACT Objective: To define physician´s behavior in the face of a mentally capable elderly dysphagic patients at risk of pulmonary aspiration, who do not accept oral restriction. Methods: Observational, cross-sectional study, presenting a clinical case of an independent elderly with clinical complaints of dysphagia and laryngotracheal aspiration by flexible endoscopic evaluation of swallowing who rejected the proposal to restrict oral diet. A questionnaire about the patient's decision-making process was used to assess whether the physician was sympathetic and justify their answer, and if they are aware of hierarchy of ethical principles (recognition of the person´s value, autonomy, beneficence, nonmaleficence and justice), in the decision-making process, and which was the main principle that guided their decision. Results: One hundred participants were classified by time since graduation as Group I (less than 10 years) and Group II (more than 10 years). Of them, 60% agreed with the patient's decision, with no difference between the groups. The main reason was autonomy of patients, in both groups. Among those who were not sympathetic, the main argument was beneficence and nonmaleficence, considering the risk between benefit and harm. As to awareness about the hierarchy of principles, we did not find differences between the groups. Autonomy was the principle that guided those who were sympathetic with the patient's decision, and justice among those who didnot agree. Conclusion: Physicians were sympathetic with the patient's decision regarding autonomy, despite the balance between risks of beneficence and nonmaleficence, including death. We propose to formalize a non-compliance term.


RESUMO Objetivo: Definir o comportamento médico diante de paciente idoso disfágico com risco de aspiração laringotraqueal e mentalmente capaz que não aceita a restrição da via oral. Métodos: Estudo observacional, transversal. Apresentamos um caso clínico de idoso, que vive independente, com queixas clínicas e videoendoscopia da deglutição comprovando disfagia e aspiração, que recusou a proposta de restrição da via oral. Um questionário foi aplicado sobre o processo de decisão do paciente, procurando avaliar se o médico torna-se solidário, e que justifique sua resposta, e se tem ciência da hierarquia dos princípios éticos (reconhecimento do valor da pessoa, autonomia, beneficência, não maleficência e justiça), no processo de decisão e qual o principal princípio que norteia sua decisão. Resultados: Cem participantes foram classificados por tempo de formados em Grupo I (até 10 anos) e Grupo II (mais de 10 anos). Deles 60% tornaram-se solidários à decisão do paciente, sem diferença entre os grupos. O principal argumento foi a autonomia do paciente nos dois grupos. Entre os não solidários, foi o binômio beneficência e não maleficência, e o balanço do risco/benefício e malefício. Considerando a ciência sobre a hierarquia dos princípios que regem a decisão, não encontramos diferença entre eles. A autonomia foi o principal princípio na decisão entre os solidários e a justiça entre os não solidários. Conclusão: O médico foi solidário à decisão do paciente em respeito à sua autonomia, apesar dos riscos ponderados da beneficência e da maleficência, inclusive de morte. Propomos o termo de recusa de conduta formalizada.


Subject(s)
Humans , Male , Aged, 80 and over , Practice Patterns, Physicians'/statistics & numerical data , Deglutition Disorders/complications , Treatment Refusal/statistics & numerical data , Respiratory Aspiration/etiology , Physician-Patient Relations , Time Factors , Gastrostomy/methods , Deglutition Disorders/prevention & control , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Gastroscopy/methods , Personal Autonomy , Respiratory Aspiration/prevention & control , Clinical Decision-Making , Intubation, Gastrointestinal/methods
13.
CoDAS ; 32(2): e20180248, 2020. tab
Article in Portuguese | LILACS | ID: biblio-1089611

ABSTRACT

RESUMO Objetivo O objetivo deste estudo foi descrever o tempo de trânsito oral total (TTOT) da deglutição em diferentes consistências de alimento na criança com acometimento neurológico (CAN) e com indicação de gastrostomia. Método Estudo clínico transversal incluiu 15 indivíduos com CAN e indicação de gastrostomia, sendo 10 do sexo masculino e cinco do sexo feminino, 13 com alimentação via oral exclusiva e dois com sonda nasogástrica, faixa etária de um a 14 anos, média de 5,7 anos, acompanhados no Grupo Multidisciplinar de Gastroenterologia Pediátrica da Universidade de Marília-UNIMAR. A deglutição foi analisada por estudo videofluoroscópico da deglutição. Foram mensuradas 19 imagens do tempo de trânsito oral total (TTOT) da deglutição, por software específico, utilizando alimento pastoso (13 imagens) e alimento líquido (seis imagens). O TTOT foi categorizado em curto ou longo baseado em definições já evidenciadas na literatura. Resultados A média e o desvio padrão para o TTOT foram, respectivamente, 10,75s e 11,76s para o pastoso e 4,22s e 1,54s para o líquido. Conclusão O tempo de trânsito oral total é longo nas consistências pastosa e líquida em crianças com acometimento neurológico e com indicação de gastrostomia.


ABSTRACT Purpose The objective of the present study was to describe the total oral transit time (TOTT) of children with neurological impairment (CNI) and with an indication of gastrostomy. Method A cross-sectional clinical study was conducted on 15 children (10 male and 5 female ranging in age from 1 to 14 years; mean 5.7 years) with CNI and gastrostomy indication. The patients were monitored by a Multidisciplinary Group of Pediatric Gastroenterology of Universidade de Marília - UNIMAR, which 13 of them with previous exclusive oral feeding and 2 fed by a nasogastric tube. Swallowing was analyzed by videofluoroscopy swallowing study and 19 images of TOTT were obtained using specific software, with analysis of pureed food (13 images) and liquid (six images). TTOT was categorized as short or long based on definitions already evidenced in the literature. Results The mean and standard deviation of TOTT values was 10.75 s and 11.76 s for pureed food and 4.22 s and 1.54 s for liquid food. Conclusion The total oral transit time of pureed or liquid consistency was long in children with neurological involvement and with an indication of gastrostomy.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Gastrostomy , Deglutition Disorders/etiology , Deglutition , Nervous System Diseases , Fluoroscopy/methods , Deglutition Disorders/surgery , Deglutition Disorders/diagnostic imaging , Cross-Sectional Studies , Enteral Nutrition/methods
14.
Cambios rev. méd ; 18(2): 92-95, 2019/12/27. ilus.
Article in Spanish | LILACS | ID: biblio-1099740

ABSTRACT

INTRODUCCIÓN. La gastrostomía endoscópica percutánea, técnica frecuente para proporcionar una vía de nutrición enteral por periodos prolongados viabiliza al uso de sonda Foley, como reemplazo a los tubos de gastrostomía convencional, representó un método fácil y económico, pero se asoció con mayor complicación y son raros los casos que se reportó. CASO CLÍNICO. Paciente de sexo masculino, de 18 años de edad, usuario de sonda Foley por 10 meses para nutrición enteral. En enteroscopia, se observó migración de la sonda e intususcepción yeyuno duodeno, que dio paso a procesos diagnósticos emergentes. RESULTADOS. Paciente de código rojo, por imposibilidad de recambio de sonda Foley, abdomen agudo, leucocitos de 15 500/ml, neutrófilos 78,8%, hemoglobina 14,0 g/l, albúmina 3,2 g/dl y proteínas 6,4g/dl. Enteroscopia duodenoyeyunal con invaginación del intestino sobre la sonda, y ero-sión de las paredes. DISCUSIÓN. La evidencia científica reportó que el uso de sonda Foley para nutrición, se utilizó de forma amplia, fue de opción económica, pero existió complicaciones prevenibles, mediante vigilancia periódica y acción emergente como el caso expuesto. CONCLUSIÓN. La vigilancia periódica de la fijación domiciliaria, el diagnóstico y protocolo de tratamiento oportuno en la entidad de salud fueron ac-ciones que permitieron resolver la intususcepción descrita con evolución satisfactoria del paciente por uso de dispositivo alternativo para nutrición.


INTRODUCTION. Percutaneous endoscopic gastrostomy, a frequent technique to provide an enteral nutrition route for prolonged periods, makes possible the use of a Foley catheter, as a replacement for conventional gastrostomy tubes, represented an easy and economical method, but it was associated with greater complication and the complications are rare. cases that were reported. CASE REPORT. Male patient, 18 years old, user of Foley catheter for 10 months for enteral nutrition. In enterosco-py, probe migration and jejunal duodenal intussusception was observed, which gave way to emerging diagnostic processes.RESULTS Red code patient, due to inability to replace a Foley catheter, acute abdomen, leukocytes of 15,500 / ml, 78,8% neu-trophils, hemoglobin 14,0 g / l, albumin 3,2 g / dl and protein 6,4g / dl. Duodeno Yeyunal enteroscopy with invagination of the intestine on the catheter, and erosion of the walls. DISCUSSION. Scientific evidence reported that the use of a Foley catheter for nutrition, was used extensively, was an economic option, but there were preven-table complications, through periodic surveillance and emerging action as the case described. CONCLUSION. Periodic monitoring of home fixation, diagnosis and timely treatment protocol in the health entity were actions that allowed solving the intussus-ception described with satisfactory evolution of the patient by use of an alternative nutrition device


Subject(s)
Humans , Male , Adolescent , Postoperative Complications , Gastrostomy , Enteral Nutrition , Endoscopy , Intussusception , Deglutition Disorders , Heart Arrest
15.
Arq. gastroenterol ; 56(4): 412-418, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055158

ABSTRACT

ABSTRACT BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is the main accepted method for long-term tube feeding. OBJECTIVE: To investigate the risk factors associated with early mortality after PEG. METHODS: Retrospective survival analysis in a tertiary-level center in Recife, Brazil. We reviewed the medical records of 150 patients with PEG placement. The data were analysed by the Kaplan-Meier method. Multivariable Cox proportional regression models were also built to test the effects of PEG on mortality. RESULTS: A total of 150 patients who submitted to PEG were studied (70 male). Of the participants, 87 (58%) had blood hypertension; 51 (34%) patients had diabetes; 6 (4%) patients had chronic renal disease; and 6 (4%) had malignancy. Chronic neurodegenerative diseases were the more common clinical indication for PEG. The 30-day and 60-day proportional mortality probability rates were 11.05% and 15.34% respectively. A multivariate Cox proportional regression model, haemoglobin (HR 4.39, 95%CI 1.30-14.81, P=0.017) and pre-procedure UCI staying (HR 0.66, 95% CI 0.50-0.87, P=0.004) were significant predictors of early mortality.A haemoglobin cut-off value of 10.05 g/dL was shown to have a sensibility of 82.6% (61.2% to 95% CI) and an acceptable sensitivity of 59.0 (50.6% to68.6% CI), and a likelihood ratio of 2.06 for eight weeks mortality. CONCLUSION: In patients who had been subjected to the PEG procedure for long-term nutrition, low haemoglobin, pre-procedure intensive care unit internment or both are associated with the risk of early mortality.


RESUMO CONTEXTO: A gastrostomia endoscópica percutânea (GEP) é o principal método aceito para a alimentação por sonda em um longo período. OBJETIVO: Investigar os fatores de risco associados à mortalidade precoce após a realização de GEP. MÉTODOS: Análise retrospectiva de sobrevida em um centro terciário em Recife, Brasil. Prontuários de 150 pacientes submetidos a colocação de GEP forma revisados. Os dados foram analisados pelo método de Kaplan-Meier. Os modelos de regressão proporcional Multivariável de Cox também foram construídos para testar os efeitos da GEP na mortalidade. RESULTADOS: Um total de 150 pacientes submetidos a GEP foram estudados (70 homens). Dos participantes, 87 (58%) tinham hipertensão arterial; 51 (34%) eram diabéticos; 6 (4%) pacientes tinham doença renal crônica e 6 (4%) tinham alguma malignidade. As doenças crônicas neurodegenerativas foram a indicação clínica mais comum para a GEP. As taxas de probabilidade de mortalidade proporcionais de 30 e 60 dias foram de 11,05% e 15,34% respectivamente. A análise multivariada por meio da regressão de Cox mostrou a hemoglobina (HR 4,39, 95% IC: 1,30-14,81, P=0,017) e a permanência em Unidade de Terapia Intensiva (UTI) (HR 0,66, 95% IC 0,50-0,87, P=0,004) como preditores significantes de mortalidade precoce. O corte no valor da hemoglobina de 10,05 g/dL mostrou uma sensibilidade de 82,6% (61,2%-95% IC) e uma sensibilidade aceitável de 59,0 (50,6%-68,6% IC), com uma taxa de 2,06 para a mortalidade em oito semanas. CONCLUSÃO: Em pacientes que foram submetidos a GEP para nutrição por um longo período, baixa hemoglobina e internamento em UTI antes do procedimento estão associados com o risco de mortalidade precoce. A GEP não deve ser indicada nesses casos.


Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Gastrostomy/mortality , Time Factors , Brazil , Gastrostomy/methods , Retrospective Studies , Risk Factors , Kaplan-Meier Estimate , Tertiary Care Centers , Middle Aged
16.
REME rev. min. enferm ; 23: e-1250, jan.2019.
Article in Portuguese | LILACS, BDENF | ID: biblio-1049059

ABSTRACT

OBJETIVOS: analisar as vivências maternas no cuidado à criança gastrostomizada e refletir sobre a atuação da equipe multiprofissional frente às demandas de cuidado identificadas. MÉTODO: estudo descritivo, exploratório, de natureza qualitativa, realizado entre os meses de dezembro de 2015 e maio de 2016 com seis mães, por meio de entrevista semiestruturada. A análise temática subsidiou a interpretação dos dados. RESULTADOS: as vivências maternas diante das necessidades da criança gastrostomizada indicam que os receios mudam ao longo da trajetória e que os modos de cuidar vão se construindo na prática cotidiana. Desse modo, cuidados inadequados são desenvolvidos no domicílio por falta de apoio e conhecimento, podendo resultar em prejuízos para a saúde da criança. CONCLUSÃO: o cuidado à criança gastrostomizada deve ser contínuo, colaborativo e compartilhado entre equipe multiprofissional e família no ambiente hospitalar e domiciliar. Atendendo às demandas singulares dessa população, evitam-se reinternações e promove-se melhor qualidade de vida à criança e família.(AU)


Objective: to analyze maternal experiences in caring for achild with gastrostomyand to reflect on the performance of the multiprofessional team regarding the identified care demands. Method: descriptive, exploratory, qualitative study, conducted between December 2015 and May 2016 with six mothers, through semi-structured interview. The thematic analysis supported the interpretation of the data. Results: maternal experiences regarding the needs of a child with gastrostomyindicate that the fears change along the trajectory and that the ways of care are being built in daily practice. Thus, inadequate care is developed at home due to lack of support and knowledge, which may result in harm to the child's health. Conclusion: the care for children with gastrostomy should be continuous, collaborative and shared between the multiprofessional team and family in the hospital and home environment. Meeting the unique demands of this population prevents readmissions and promotes better quality of life for children and families.(AU)


Objetivo: analizar las experiencias maternas en el cuidado del niño ostomizado y reflexionar sobre el desempeño del equipo multiprofesional con respecto a las demandas de atención identificadas. Método: estudio descriptivo, exploratorio, cualitativo, realizado entre diciembre de 2015 y mayo de 2016 con seis madres, por medio de una entrevista semiestructurada. La interpretación de datos se efectuó en base al análisis temático. Resultados: las experiencias maternas con respecto a las necesidades del niño ostomizado indican que los temores cambian a lo largo del tiempo y que las formas de cuidado se construyen en la práctica diaria. Por lo tanto, cuando la atención en el hogar es inadecuada por falta de apoyo y conocimiento, la salud del niño puede resultar...(AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Patient Care Team , Gastrostomy , Child Health , Socioeconomic Factors , Child Health Services
17.
Clinical Endoscopy ; : 616-619, 2019.
Article in English | WPRIM | ID: wpr-785661

ABSTRACT

Continuous duodenal levodopa/carbidopa intestinal gel delivery by a gastrostomy infusion system improves control of Parkinson’s disease. The overall complication rates of percutaneous endoscopic gastrojejunostomy were reported to be 41% and 59% for immediate and delayed adverse events, respectively. A 72-year-old woman underwent percutaneous endoscopic gastrojejunostomy using the delivery system noted above. Abdominal pain and vomiting occurred 3 months later. Esophagogastroduodenoscopy showed a longitudinal ulcer extending from the lower gastric body to the ileum end, with small intestinal telescoping. Colonoscopy showed a large bezoar of food residue that was attached around the tip of the tube, reaching the ascending colon, which may have acted as an anchor. Thus, the gastric antrum and small intestine were shortened with telescoping. This complication was resolved by crushing the bezoar with forceps during colonoscopy and can be prevented by consuming a fiber-free diet and periodic exchanges of the tube using esophagogastroduodenoscopy.


Subject(s)
Abdominal Pain , Aged , Bezoars , Colon , Colon, Ascending , Colonoscopy , Diet , Endoscopy, Digestive System , Female , Gastric Bypass , Gastrostomy , Humans , Ileum , Intestine, Small , Pyloric Antrum , Surgical Instruments , Ulcer , Vomiting
18.
Article in English | WPRIM | ID: wpr-719682

ABSTRACT

Buried bumper syndrome is a rare but potentially severe complication of percutaneous endoscopic gastrostomy tube insertion. Though this complication is uncommon, it may lead to pressure necrosis, bleeding, perforation, peritonitis, sepsis, or death. Each case of buried bumper syndrome is unique in terms of patient comorbidities and anatomic positioning of the buried bumper. For this reason, many approaches have been described in the management of buried bumper syndrome. In this case report, we describe the case of an adolescent Caucasian female who developed buried bumper syndrome three years after undergoing percutaneous endoscopic gastrostomy insertion. We review diagnosis and management of buried bumper syndrome and describe a novel technique for bumper removal in which we use a guide wire in combination with external traction to maintain a patent gastrostomy lumen while removing the internal percutaneous endoscopic gastrostomy bumper.


Subject(s)
Adolescent , Catheterization , Comorbidity , Diagnosis , Endoscopy , Female , Gastroenterology , Gastrostomy , Hemorrhage , Humans , Necrosis , Pediatrics , Peritonitis , Sepsis , Traction
19.
Rev Rene (Online) ; 20: e41432, 2019. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1040992

ABSTRACT

Objetivo descrever o perfil clínico epidemiológico de crianças submetidas à cirurgia de gastrostomia. Métodos estudo transversal, documental, retrospectivo desenvolvido em um hospital de referência em saúde da criança. Os dados foram coletados em prontuários e no livro de cirurgias. Resultados entre 39 prontuários analisados a maioria é do sexo feminino, nascidos de parto vaginal, idade gestacional a termo, sem informação sobre o índice de APGAR, com alguma comorbidade, idade entre 0-3 anos. A principal indicação para gastrostomia foi o distúrbio de deglutição de origem muscular ou neurológica com predomínio da técnica cirúrgica, uso de cateter de foley em látex como dispositivo para nutrição enteral, a primeira troca do dispositivo ocorreu entre 21 a 30 dias realizada pelo enfermeiro. Conclusão constatou-se a prevalência de meninas, com idade entre zero a três anos com alguma comorbidade. Os distúrbios de deglutição constituíram a indicação de gastrostomia confeccionada por meio de técnica cirúrgica.


Objective to describe the epidemiological clinical profile of children undergoing gastrostomy surgery. Methods cross-sectional, documentary, retrospective study developed at a referral hospital for child health. Data were collected from records and in the surgery book. Results among 39 medical records analyzed, most were female, born vaginally, gestational age at term, with no information on the Apgar index, with some comorbidity, aged 0-3 years. The main indication for gastrostomy was the swallowing disorder of muscular or neurological origin with predominance of the surgical technique, use of latex Foley catheter as a device for enteral nutrition, the first exchange of the device occurred between 21 to 30 days performed by the nurse. Conclusion the prevalence of girls aged zero to three years with some comorbidity was found. Swallowing disorders were the indication of gastrostomy made by surgical technique.


Subject(s)
Humans , Child , Health Profile , Gastrostomy , Catheters , Nursing Care , Child
20.
Acta cir. bras ; 34(6): e201900610, 2019. graf
Article in English | LILACS | ID: biblio-1019268

ABSTRACT

Abstract Purpose To identify whether the colon mucosa is affected by ten days of gastric restriction in an animal model. Methods An experimental model of gastric restriction was devised using rats. The animals were submitted to surgical gastrostomy, and a cylindrical loofah was inserted into the stomach. We studied 30 adult male Wistar rats divided into three groups: the stomach restriction group (R10); the sham group (S10), which underwent the same procedure except for the loofah insertion; and the control group (C10). The expression of neutral and acid mucins was evaluated using histochemical techniques. Goblet cells and protein content were compared between groups using generalized estimation equations (GEEs). Bonferroni's multiple comparison was applied to identify differences between the groups. All tests considered a 5% significance level. Results There was an increased expression of neutral mucins, acid mucins and goblet cells in the R10 group. Collagen was also enhanced in the R10 group. Conclusion The colon mucosa is affected by ten days of gastric restriction in an animal model, increasing neutral mucins, acid mucins and collagen content with trophic maintenance.


Subject(s)
Animals , Male , Rats , Food Deprivation , Intestinal Mucosa/metabolism , Mucins/metabolism , Time Factors , Gastrostomy , Rats, Wistar , Colon , Models, Animal , Intestinal Mucosa/pathology
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